In 2007, I published a story in my local paper in which I confessed to having made a medical error years earlier. I’d mistakenly prescribed an antibiotic for a patient whose chart indicated an allergy to the drug.
Thankfully, the story had a happy ending. My patient recovered and took no legal action after I explained to her what had happened. I ended my article vowing to take greater care to prevent errors and urging doctors to take responsibility for their mistakes, even when a patient hasn’t been harmed.
The response among many of my colleagues was: Why? If a patient makes a full recovery, why should doctors admit to a mistake that might have otherwise gone unnoticed? Our intentions as doctors are good, and confessing our errors would only create unnecessary personal humiliation and undermine our authority. Moreover, what if the patient looks at an admission of error as a winning ticket in the malpractice lottery?
Like me, many of my colleagues were never taught how to disclose errors in medical school. Errors were considered incidental lapses and used as teaching points among residents; we were not to discuss them with patients unless absolutely necessary. When I joined a private practice 18 years ago, our hospital and malpractice lawyers told us never to admit guilt. Risk managers were clear that we were to contact them in the event of an error. If patients’ families had questions, we were to be vague with our responses, essentially brushing them off.
Gradually, such attitudes and practices have been changing. First, policymakers, doctors and other providers have realized that medical errors are often systemic problemsrather than incidental lapses. And error disclosures, once considered an ethical obligation to be treated as a problem only if a patient sued, are now being written into hospital policy.
In 2001, the organization that accredits hospitals developed national standards for a more coordinated approach to reporting errors and protecting patients, and from 2002 to 2005 the proportion of hospitals with disclosure policies doubled to 70 percent, according to a 2007 New England Journal of Medicine article. (A 2002 NEJM study had found that only one in three preventable medical errors was being disclosed to patients.) The national standards require that patients be informed of all outcomes of care, including “unanticipated outcomes.”
While this policy shift alerted physicians like me to a change in perspective, it did little to change our behavior. Many doctors were trained in an autocratic and sometimes patronizing culture, and there were few incentives or penalties to push change.
In 2006, a working group representing Harvard-affiliated hospitals established that a disclosure policy must include three elements: The provider must take responsibility, apologize and discuss preventive measures with the patient or the family.
For example, if I inadvertently gave penicillin to a patient with a known allergy and she had a reaction, I would tell the patient I had made an error, apologize for my mistake and talk about how I will make an effort to prevent making such an error in the future. Washington Post Link